Systematic Review Of Evidence Research Articles

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence.

Child marriage and teen pregnancy have negative health, social and development consequences. Highest rates of child marriage occur in sub-Saharan Africa (SSA) and 40% of women in Western and Central Africa got married before the age of 18. This systematic review was aimed to fill a gap in evidence of effectiveness to reduce teen pregnancy and child marriage in SSA. We considered studies conducted in sub-Saharan Africa that reported on the effect of interventions on child marriage and teen pregnancy among adolescent girls for inclusion. We searched major databses and grey literature sources. We included 30 articles in this review. We categorized the interventions reported in the review into five general categories: (a) Interventions aimed to build educational assets, (b) Interventions aimed to build life skills and health assets, (c) Wealth building interventions, and (d) Community dialogue. Only few interventions were consistently effective across the studies included in the review. The provision of scholarship and systematically implemented community dialogues are consistently effective across settings. Program designers aiming to empower adolescent girls should address environmental factors, including financial barriers and community norms. Future researchers should consider designing rigorous effectiveness and cost effectiveness studies to ensure sustainability. https://www.crd.york.ac.uk/prospero/, identifier: CRD42022327397.

Characteristics of the sources, evaluation, and grading of the certainty of evidence in systematic reviews in public health: A methodological study.

To systematically explore how the sources of evidence, types of primary studies, and tools used to assess the quality of the primary studies vary across systematic reviews (SRs) in public health. We conducted a methodological survey of SRs in public health by searching the of literature in selected journals from electronic bibliographic databases. We selected a 10% random sample of the SRs that met the explicit inclusion criteria. Two researchers independently extracted data for analysis. We selected 301 SRs for analysis: 94 (31.2%) of these were pre-registered, and 211 (70.1%) declared to have followed published reporting standard. All SRs searched for evidence in electronic bibliographic databases, and more than half (n = 180, 60.0%) searched also the references of the included studies. The common types of primary studies included in the SRs were primarily cross-sectional studies (n = 132, 43.8%), cohort studies (n = 126, 41.9%), randomized controlled trials (RCTs, n = 89, 29.6%), quasi-experimental studies (n = 83, 27.6%), case-control studies (n = 58, 19.3%) qualitative studies (n = 38, 12.6%) and mixed-methods studies (n = 32, 10.6%). The most frequently used quality assessment tools were the Newcastle-Ottawa Scale (used for 50.0% of cohort studies and 55.6% of case-control studies), Cochrane Collaboration's Risk of Bias tool (50.7% of RCTs) and Critical Appraisal Skills Program (38.5% of qualitative studies). Only 20 (6.6%) of the SRs assessed the certainty of the body of evidence, of which 19 (95.0%) used the GRADE approach. More than 65% of the evidence in the SRs using GRADE was of low or very low certainty. SRs should always assess the quality both at the individual study level and the body of evidence for outcomes, which will benefit patients, health care practitioners, and policymakers.

The use of sentiment and emotion analysis and data science to assess the language of nutrition-, food- and cooking-related content on social media: a systematic scoping review.

Social media data are rapidly evolving and accessible, which presents opportunities for research. Data science techniques, such as sentiment or emotion analysis which analyse textual emotion, provide an opportunity to gather insight from social media. This paper describes a systematic scoping review of interdisciplinary evidence to explore how sentiment or emotion analysis methods alongside other data science methods have been used to examine nutrition, food and cooking social media content. A PRISMA search strategy was used to search nine electronic databases in November 2020 and January 2022. Of 7325 studies identified, thirty-six studies were selected from seventeen countries, and content was analysed thematically and summarised in an evidence table. Studies were published between 2014 and 2022 and used data from seven different social media platforms (Twitter, YouTube, Instagram, Reddit, Pinterest, Sina Weibo and mixed platforms). Five themes of research were identified: dietary patterns, cooking and recipes, diet and health, public health and nutrition and food in general. Papers developed a sentiment or emotion analysis tool or used available open-source tools. Accuracy to predict sentiment ranged from 33·33% (open-source engine) to 98·53% (engine developed for the study). The average proportion of sentiment was 38·8% positive, 46·6% neutral and 28·0% negative. Additional data science techniques used included topic modelling and network analysis. Future research requires optimising data extraction processes from social media platforms, the use of interdisciplinary teams to develop suitable and accurate methods for the subject and the use of complementary methods to gather deeper insights into these complex data.

Global coverage of interventions to prevent and manage drug-related harms among people who inject drugs: a systematic review

Harm reduction and treatment programmes are essential for reducing harms for people who inject drugs (PWID). We aimed to update estimates from a 2017 review of global coverage of needle and syringe exchange programmes (NSPs), opioid agonist treatment (OAT), and other harm reduction services that target PWID (eg, take-home naloxone [THN] programmes, supervised consumption facilities, and drug checking services). We did a systematic review of available evidence from peer-reviewed and grey literature databases for studies published between Jan 1, 2017, and May 31, 2022. Programmatic data were collected on the availability of services, the number of sites, people accessing services, and equipment distributed in countries where there is evidence of injecting drug use. National estimates of coverage of OAT (ie, number of people accessing OAT per 100 PWID) and NSPs (ie, number of needles and syringes distributed per PWID per year) were generated where available using the most recent data. Regional and global estimates were derived and compared with WHO indicators. The study was registered with PROSPERO (CRD42020173974). We included 195 studies and found there were 90 countries implementing OAT (75% of the PWID population) and 94 countries implementing NSPs (88% of the global PWID population). Only five countries (2% of the global PWID population) are providing high coverage of both services. Far fewer countries were implementing THN programmes (n=43), supervised consumption facilities (n=17), and drug checking services (n=26), with nine countries implementing all five services. Globally, we estimated there were 18 (95% uncertainty interval [UI] 12-27) people accessing OAT per 100 PWID, and 35 (95% UI 24-52) needles and syringes being distributed per person who injects drugs per year. More countries reported high (OAT 24; NSPs 10), moderate (OAT 8; NSPs 15), and low (OAT 38; NSPs 47) coverage of services compared with the previous review. Global coverage of OAT and NSPs has increased modestly in the past 5 years but remains low for most countries. Programmatic data on other key harm reduction interventions are scarce. Australian National Health and Medical Research Council.

Hydrogels for Wound Dressing Applications - A Systematic Review

Aim: To discuss the currently available hydrogel wound dressings and their clinical effectiveness. Method: PubMed/Medline, HEC Digital Library, Wiley Online Library, Wolter Kluwer, Elsevier, and Google Scholar from the year 2013 to 2021 were searched to identify relevant clinical trials and studies. Results: Forty-three studies that assessed hydrogel vs. non-hydrogel dressings were identified. Compared to the latter, hydrogel dressings associated with a significantly shortened healing time of degree II burn (superficial and deep) wounds, diabetic foot ulcers, traumatic skin injuries, radioactive skin injuries, dog bites, and body surface ulcers. In addition, hydrogel dressing obviously increased the cure rate of diabetic foot ulcers, surgical wounds, dog bites, and body surface ulcers. Moreover, hydrogel dressing significantly relieved pain in degree II burn (superficial and deep) wounds, traumatic skin injuries and laser treatment-induced wounds. However, no significant differences obtained between hydrogel and non-hydrogel dressings in the healing time of surgical wounds, the cure rate of inpatients' pressure ulcers, and phlebitis ulcers. Conclusion: This comprehensive systematic review of the available evidence reveals that the application of hydrogel dressings advances the healing of various wound types and effectively alleviates the pain with no severe adverse reactions. These results strongly indicate that hydrogel products are effective and safe in wound management. Keywords: Hydrogels, wound dressing, surgical wounds, diabetic ulcer, burns.

Renewed call to improve approaches for developing fetal alcohol spectrum disorder diagnostic criteria: Commentary on "Comparison of three systems for the diagnosis of fetal alcohol spectrum disorders in a community sample".

Renewed call to improve approaches for developing fetal alcohol spectrum disorder diagnostic criteria: Commentary on "Comparison of three systems for the diagnosis of fetal alcohol spectrum disorders in a community sample".

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Effectiveness of telemedicine diabetic retinopathy screening in the USA: a protocol for systematic review and meta-analysis

BackgroundDiabetic retinopathy (DR) is the leading cause of vision loss among adults in the USA. Vision loss associated with diabetic retinopathy can be prevented with timely ophthalmologic care, and therefore, it is recommended that individuals with diabetes have annual retinal examinations. There is limited evidence on whether using telemedicine to screen for DR in primary care clinics in the USA effectively leads to increased DR screening rates. The objective of this systematic review is to collate evidence from existing studies to investigate the effectiveness of telemedicine DR screening (TDRS) in primary care clinics on DR screening rates.MethodsRelevant studies will be identified through searching MEDLINE/PubMed interface, Scopus, and Web of Science from their inception until November 2021, as well as searching reference lists of included studies and previous related review articles or systematic reviews. There will be no restrictions on study design. Eligible studies will include subjects with either type 1 or type 2 diabetes, will evaluate telemedicine technology for screening of DR, will have been conducted in the USA, and will report DR screening rates or data necessary for calculating such rates. Two reviewers will screen search results independently. Risk-of-bias assessment and data extraction will be carried out by two reviewers. The version 2 of the Cochrane risk-of-bias tool (RoB 2) and the Newcastle-Ottawa scale (NOS) tool will be used to assess the quality and validity of individual studies. If feasible, we will conduct random-effects meta-analysis where appropriate. If possible, we will conduct subgroup analyses to explore potential heterogeneity sources (setting, socio-economic status, age, ethnicity, study design, outcomes). We will disseminate the findings through publications and relevant networks.DiscussionThis protocol outlines the methods for systematic review and synthesis of evidence of TDRS and its effect on DR screening rates. The results will be of interest to policy makers and program managers tasked with designing and implementing evidence-based services to prevent and manage diabetes and its complications in similar settings.Systematic review registrationPROSPERO CRD42021231067.

Automating Quality Assessment of Medical Evidence in Systematic Reviews.

Assessment of the quality of medical evidence available online is a critical step in the systematic review of clinical evidence. Existing tools that automate parts of this task validate the quality of individual studies but not of entire bodies of evidence, and focus on a restricted set of quality criteria. We propose a quality assessment task that consists of providing an overall quality rating for each outcome, as well as finer-grained justification for different quality criteria according to the GRADE formalisation framework. For this, we construct a new dataset and develop a machine-learning baseline system (EvidenceGRADEr). Our goal is to work towards evaluating the quality of a body of evidence (BoE) for a specific clinical question, rather than assessing the quality of individual primary studies. We algorithmically extracted quality-related data from all summaries of findings found in the Cochrane Database of Systematic Reviews (CDSR). Each BoE is defined by a set of PICO criteria (population-intervention-comparison-outcome) and assigned a quality grade (high/moderate/low/very low) together with quality criteria (justification) that influenced that decision. Different statistical data, metadata about the review, and parts of review text are extracted as support for grading each BoE. After pruning the resulting dataset with various quality checks, we used it to train several variants of a feature-rich neural model. The predictions were compared against the labels originally assigned by the authors of the systematic reviews. Our quality assessment dataset, CDSR-QoE, contains 13,440 instances, or BoEs labelled for quality, originating from 2,252 systematic reviews published on the Internet in the years 2002--2020. Based on 10-fold cross-validation, the best neural binary classifiers for quality criteria detect risk of bias at .78 F1 (P: .68, R: .92) and imprecision at .75 F1 (P: .66, R: .86), while the performance on inconsistency, indirectness and publication bias criteria is lower (F1 in the range of .3-.4). The prediction of the overall quality grade into one of the four levels results in 0.5 F1. When casting the task as a binary problem by merging the GRADE classes (high+moderate vs. low+very low quality evidence), we attain .74 F1. We also find that the results vary depending on what supporting information is provided as input to the models. There are different factors affecting the quality of evidence in the context of systematic reviews of medical evidence. Some of them (risk of bias and imprecision) can be automated with reasonable accuracy. Other quality dimensions such as indirectness, inconsistency, and publication bias prove more challenging for machine learning, largely because they are much rarer. This technology could substantially reduce reviewer workload in the future and expedite quality assessment as part of evidence synthesis.

Evaluation of the use of GRADE in dentistry systematic reviews and its impact on conclusions: a protocol for a methodological study

BackgroundThere is a growing body of evidence of systematic reviews (SRs) with varying degrees of methodological quality. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach allows SR authors to assess the certainty of the evidence they found and transparently relay their conclusions. As there appears to be infrequent utilization of GRADE in the field of dentistry, to identify the impact of GRADE, the aim of this study is to evaluate the use of GRADE in the dental literature and determine whether SRs that use GRADE differ from those that do not with respect to their conclusions.Methods/designWe will search Ovid MEDLINE for SRs published from 2016 to the present. We will conduct both screening and data extraction independently and in duplicate and use pre-piloted, standardized forms for data extraction. We will determine the frequency of the use of GRADE and the varying levels of certainty in the current literature and evaluate whether GRADE is being used appropriately. We will also evaluate whether SRs not using GRADE differ from those that use GRADE with regard to methodological quality. We will also determine whether the conclusions of SRs that do not use GRADE would change had GRADE been utilized. Additionally, we will evaluate whether SRs using GRADE are more likely to formulate appropriate conclusions compared to SRs that do not use it.DiscussionThis study will investigate the frequency of GRADE assessments in dentistry SRs and the impact of GRADE assessments on the conclusions of a SR. It has important implications for both SR authors and users of this type of literature.

Influence of habitat alteration on the structure of helminth communities in small mammals: a systematic review and critical appraisal of theory and current evidence.

Despite the extensive information on the effects of habitat alteration on the structure of helminth communities in small mammals, the evidence is still inconclusive. A systematic review was carried out using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guideline to compile and synthesize available literature on the influence of habitat alteration on the structure of helminth communities in small mammals. The aim of this review was to describe the variation in infection rates of helminth species associated with habitat alteration and to discuss the theoretical framework that may explain such changes in relation to parasite, host, and environmental features. Twenty-three scientific articles published between 2005 and 2022 were reviewed, 22 of which investigated parasite prevalence, 10 parasite burden, and 14 parasite richness in both altered and natural habitats. Information in assessed articles suggests that the structure of helminth communities in small mammals can be impacted by anthropogenic habitat alteration in various ways. Infection rates of monoxenous and heteroxenous helminths may increase or decrease in small mammals depending on whether their hosts (definitive and intermediate) are available, and environmental and host conditions modify the survival and transmission of parasitic forms. Also, given that habitat alteration may favor inter-species contacts, transmission rates of low host-specific helminths could be increased due to exposure to new reservoir hosts. In a continually changing world, it is essential to assess the spatio-temporal variations of helminth communities in wildlife inhabiting altered and natural habitats to determine potential impacts on wildlife conservation and public health.

Impact of, and mitigation measures for, burnout in frontline healthcare workers during disasters: A mixed-method systematic review.

Burnout is a global concern for the healthcare community, especially following a disaster response. It is a major obstacle to providing safe and quality health care. Avoiding burnout is essential to ensuring adequate healthcare delivery and preventing psychological and physical health problems and errors among healthcare staff. This study aimed to determine the impact of burnout on healthcare staff working on the frontline in a disaster context, including pandemics, epidemics, natural disasters, and man-made disasters; and to identify interventions used to mitigate burnout among those healthcare professionals before, during, or after the disaster. A mixed methods systematic review was used and included a joint analysis and synthesis of data from qualitative and quantitative studies. The was guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) of qualitative and quantitative evidence. Several databases were searched, for example, Medline, Embase, PsycINFO, Web of Science, Scopus, and CINAHL. The quality of included studies was assessed using the Mixed Method Appraisal Tool (MMAT), version 2018. Twenty-seven studies met the inclusion criteria. Thirteen studies addressed the impact of burnout in relation to disasters and highlighted the association between burnout and the physical or mental well-being of healthcare workers, work performance, and workplace attitude and behavior. Fourteen studies focused on different burnout interventions including psychoeducational interventions, reflection and self-care activities, and administering a pharmacological product. Stakeholders should consider reducing risk of burnout among healthcare staff as an approach to improving quality and optimizing patient care. The evidence points to reflective and self-care interventions having a more positive effect on reducing burnout than other interventions. However, most of these interventions did not report on long-term effects. Further research needs to be undertaken to assess not only the feasibility and effectiveness but also the sustainability of interventions targeted to mitigate burnout in healthcare workers.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Abstract P1-12-07: Management of genitourinary symptoms in breast cancer patients: An updated systematic review of available evidence from randomized trials

Abstract Background: Genitourinary symptoms (GUS) such as vaginal dryness, dyspareunia, itching, urinary incontinence, urinary tract infections and discharge are common in patients with breast cancer (BC). Optimal management of GUS remains unclear. Our group previously published a systematic review (SR) on GUS management in 2014 which showed a paucity of RCT evidence addressing this knowledge gap (Mazzarello et al. 2015). We performed an updated SR to assess if more prospective trial data had been published in the past 7 years to inform management of this common complication of BC. Methods: EMBASE, Ovid Medline and the Cochrane Library were searched for RCTs evaluating treatments for GUS in BC patients from September 2014 to December 2021. A PICOS (population, intervention/comparators, outcomes and study design) framework was utilized. Population: women with breast cancer. Intervention/comparators: all forms of oral, intra-vaginal and topical hormonal and non-hormonal treatments. Outcomes of interest: improvements in vaginal symptoms (e.g., dryness, pain, dyspareunia, itching); vaginal hormone response, measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)] and quality of life [e.g., Female Sexual Function Index (FSFI)]. Study design: only RCTs were included. Two independent reviewers performed the tasks of study selection, data collection, and risk of bias assessment. Results: Of 842 unique citations identified (412 from this update, 430 from previous SR), eight studies (n = 539 patients) met inclusion criteria. Interventions included 0.005% estriol gel (EG; n=50 patients), intravaginal testosterone (IVT; n=21), intravaginal prebiotic (n=13), hyaluronic acid (HA; n=12), polyacrylic acid (PA; n=25), pH-balanced gel (two studies; n=118), Replens(n=24) and Lidocaine gel (n=22). These interventions were compared to placebo/saline/usual care (n=254). One study had three arms comparing prebiotics, HA and usual care. Study sample sizes ranged from 44 to 136 patients. Given the heterogeneity of the studies, a narrative synthesis was performed. Compared to placebo, FSFI total score was significantly improved by all interventions except IVT (which demonstrated significant improvement in only the satisfaction domain) and 4% aqueous lidocaine before vaginal penetration (which improved significantly all domains except for orgasm). FSFI changes were not reported for Replens. Significant improvements in vaginal hormone responses (VHI and VMI) were reported for 0.005% EG and pH-balanced gel; however, no significant effects were found for IVT, HA or prebiotics. Vaginal symptoms (vaginal dryness, dyspareunia and pruritis) were significantly improved by EG, IVT, and PA. Vaginal symptoms were significantly improved in the single study of pH-balanced gel that reported this outcome. Conclusion: GUS is reported in 75% of BC patients but despite its frequency, the management of GUS remains a challenging issue for patients and health care providers. Due to study heterogenicity, there remains insufficient RCT evidence to define optimal therapy. More prospective trials comparing commonly used interventions are needed. Keywords: Genitourinary symptoms, Topical moisturizers, Intra-vaginal testosterone Citation Format: Parvaneh Fallah, Dianna M. Wolfe, Brian Hutton, Mark Clemons, Risa Shorr, Lisa Vandermeer, Moira Rushton-Marovac. Management of genitourinary symptoms in breast cancer patients: An updated systematic review of available evidence from randomized trials [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-12-07.

Quantitative assessment of aflatoxin exposure and hepatocellular carcinoma (HCC) risk associated with consumption of select Nigerian staple foods

Aflatoxin contamination of staple grains and legumes has been linked to hepatocellular carcinoma (HCC) and other adverse health outcomes, constituting a substantial public health concern globally. Low-resource food environments in sub-Saharan Africa are often under-regulated and are particularly vulnerable to adverse health and nutrition outcomes associated with aflatoxin exposure. This study identifies levels of HCC risk in the northern Nigerian adult population, leveraging a systematic review of available evidence on aflatoxin contamination in Nigerian maize, groundnut, rice, cowpea, and soybean. Estimated dietary intake (EDI) was computed using publicly available dietary consumption data and a probabilistic quantitative risk assessment was conducted to determine the relative risk of HCC associated with consumption of selected aflatoxin-contaminated commodities. In total, 41 eligible studies reporting aflatoxin contamination were used to model the distribution of aflatoxin concentrations in Nigerian commodities. EDIs for maize, groundnut, rice, and cowpea exceeded the provisional maximum tolerable daily intake (PMTDI) level of 1 kgbw-1 day-1, with maize yielding the highest mean EDI (36.7 kgbw-1 day-1). The quantitative risk assessment estimated that 1.77, 0.44, 0.43, 0.15, and 0.01 HCC cases per year/100,000 population were attributable to aflatoxin exposure through maize, groundnut, rice, cowpea, and soybean, respectively. Sensitivity analysis revealed that aflatoxin concentration, dietary consumption levels, consumption frequency, and other variables have differing relative contributions to HCC risk across commodities. These findings constitute a novel multi-study risk assessment approach in the Nigerian context and substantiate existing evidence suggesting that there is reason for public health concern regarding aflatoxin exposure in the Nigerian population.

PROTOCOL: Treatment for depressive disorder among adults: An evidence and gap map of systematic reviews.

This is the protocol for a Campbell evidence and gap map.The objective of the map is to map available systematic reviews on the effectiveness of treatments for depressive disorders among adults. Specifically, this EGM includes studies on the effectiveness of treatments across a range of outcome domains.

Joint 2022 European Society of Thoracic Surgeons and The American Association for Thoracic Surgery guidelines for the prevention of cancer-associated venous thromboembolism in thoracic surgery.

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis.

Immune Supplements Under the Magnifying Glass: An Expert Panel Develops Priorities and Evidence-Based Recommendations for Future Research Regarding Dietary Supplements.

Immune Supplements Under the Magnifying Glass: An Expert Panel Develops Priorities and Evidence-Based Recommendations for Future Research Regarding Dietary Supplements.

An umbrella review of the acceptability of fiscal and pricing policies to reduce diet-related noncommunicable disease.

Poor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health. To examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence. MEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021. The studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained. Quality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment. The findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020]. PROSPERO registration no. CRD42021274454.

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials.

In recent years, various clinical trials have focused on treating knee osteoarthritis (KOA) with multiple injections of platelet-rich plasma (PRP). However, compared with the multiple hyaluronic acid (m-HA) injections, the clinical efficacy of multiple PRP (m-PRP) injections for KOA still remains controversial among these studies. Therefore, we aimed to compare the clinical effectiveness of m-PRP injections with m-HA injections in the treatment of KOA in this systematic review. Relevant clinical trials were searched via bibliographic databases, including Medline, PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, to compare the m-PRP and m-HA injections in the treatment of KOA. Finally, fourteen randomized controlled trials, including 1512 patients, showed the postoperative VAS, WOMAC, IKDC, or EQ-VAS scores and were enrolled in this systematic review. Compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was lower in the VAS scores at 3-month (WMD = -0.25; 95%CI, -0.40 to -0.10, p = 0.0009) and 12-month (WMD = -0.64; 95%CI, -0.79 to -0.49, p < 0.00001) follow-ups. In addition, the group of intra-articular m-PRP injections was also lower in the WOMAC scores at 1-month (WMD = -1.23; 95%CI, -2.17 to -0.29, p = 0.01), 3-month (WMD = -5.34; 95%CI, -10.41 to -0.27, p = 0.04), 6-month (WMD = -11.02; 95%CI, -18.09 to -3.95, p = 0.002), and 12-month (WMD = -7.69; 95%CI, -12.86 to -2.52, p = 0.004) follow-ups. Furthermore, compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was higher in the IKDC scores at 3-month (WMD = 7.45; 95%CI, 2.50 to 12.40, p = 0.003) and 6-month (WMD = 5.06; 95%CI, 1.94 to 8.18, p = 0.001) follow-ups. However, the long-term adverse side of m-PRP injections for KOA still needs more large-scale trials and long-term follow-ups.